THE STAGING PELVIC LYMPHADENECTOMY - IMPLICATIONS AS AN ADJUNCTIVE PROCEDURE FOR CLINICALLY LOCALIZED PROSTATE-CANCER

Objectives To evaluate the utility of staging pelvic lymphadenectomy a nd to identify factors associated with nodal metastases in which a nod e dissection would be of clinical benefit. Patients and methods A retr ospective analysis (1989-1993) was performed on 303 consecutive patien ts who underwent staging bilateral modified pelvic lymph node dissecti on for clinically localized prostate cancer. Multivariate logistic reg ression analysis was used to evaluate age, race, clinical stage, prost ate-specific antigen (PSA) level and Gleason score for predicting noda l metastases.Results Twenty-eight patients had nodal metastases, givin g an overall prevalence of 9.2%. PSA and Gleason score (both P<0.001) were significantly predictive of nodal involvement when combined or as independent variables. Relative to PSA and Gleason score, the patient s' age, race and clinical stage were less relevant. Sensitivity analys is determined that combining a PSA of greater than or equal to 20 ng/m L (normal 0-4) and a Gleason score of greater than or equal to 8 gave a negative predictive value of 92% with a specificity of 99%, a positi ve predictive value of 67% and an overall accuracy of 91% for predicti ng nodal metastases. Conclusion From this data, lymph node metastases are unlikely in patients with clinically localized prostate cancer who have a PSA of < 20 ng/mL and a Gleason score <8, and that a pelvic ly mph node dissection as an adjunctive procedure should be avoided in su ch individuals.